'Fast-bowling injuries account for two-thirds of games missed in a year'

Australia's lead physio Alex Kountouris talks about injury management, and how there was really never any rotation policy

Subash Jayaraman: You have been associated with international cricket as a physio for nearly 20 years now, first, with Sri Lanka and now with Australia. How have the roles of physiotherapist, the technology involved, the player-monitoring systems and strategies changed?

Alex Kountouris: In the past, we have gone on how people feel, and experiences in an area. That works well, but what we have got now is a database of information for the last ten to 15 years that is invaluable. We know what people have done in the past and what they are capable of doing and we try to use that information to better prepare the modern-day player so they can also play well and minimise the risk of injury.

SJ: Your title says you are the "lead physiotherapist" with the Australian cricket team, which means there are other physios working with you. What are the things that you guys do as a team of physios on a daily basis when you are with the Australian cricket team?

AK: It is not just a team of physios - there are physios, strength-and-conditioning coaches, nutritionists, doctors. We call it the "sports science and sports medicine team". As a physiotherapist you have your day-to-day injury management. We see players and treat their injuries. We work with the coaches, fitness coaches, nutritionists and the sports psychologists.
Sometimes things happen that are out of your control. A couple of years ago where a player broke down in the game, Peter Siddle ended up bowling 63 overs in a Test. That was unexpected and we had to adapt to the situation. We had some great plans going into that series, but sometimes, when you are dealing with human beings and athletes, things happen and you have to make an alternative plan, which we are always prepared to do.

SJ: There is a question from a listener, Abhishek: Are there inherent differences in your approach to fitness and your players' approach to fitness when working with Asian teams v non-Asian teams?

AK: That is a good question and something people have asked before. I worked with the Sri Lankan team first from 1995 to 2003. What we did with fitness back then is different from what we are doing now. But I am consistent with what other teams were doing at that time. In terms of physical attributes and attitude towards training, with respect to the work that they had to do, both sets of players were equal. Sri Lankan players worked extremely hard and that is the same with the Australian players here now. You can get to the international level, without ticking every single box, but to stay there and play for a long time you need to be working very hard on all aspects of your game. The fitness side is one area that you have to stay on top of if you want a long career!

SJ: Would it be safe to assume that the team of doctors and physios spend a lot more time with the bowlers, especially the pacers, than the batsmen?

AK: Yeah, that tends to work out that way. We have just released some of our injury information from last year - fast-bowling injury accounts for more than two-thirds of the games missed throughout the year. Fast bowlers spend more time out injured than any other players, and hence we spend more time concentrating on their preparation and planning their programmes.

Right now, we have already got plans in place until we play Pakistan in the UAE in October.

SJ: When you say "plans", could you be a bit more detailed, because I don't think I have seen the insides of a gym in about ten years?

AK: The areas we concentrate on are making sure their physical and mental preparation is ready. From the physical side of things we look at their strength programme. They have a fitness programme to make them as fit as possible. Importantly for the bowlers, we plan how many balls they ought to be bowling, how often, and what kind of workload they have leading into the tournament. We know if they have coped in the past and what they haven't coped with, and we try to plan an optimal load going into each game or tournament. It is easy to plan but hard to implement, but we get there.

SJ: How do you establish, for example, bowler A is to be put through a certain amount and bowler B is to put through certain other amount of load? Is it just historical data, or can you come up with numbers with certain evaluations?

AK: Broadly speaking, age is a huge determinant. We know younger players can't cope with the same amount of bowling as the older players. The ones with the better and safer techniques are going to be able to cope more than the guys who haven't got quite a safe technique. We look at the injury history, at what they have had before, and what they are prone to getting. We look at how they respond to each session, and after every session they do, they give us information on how they felt, which is automatically sent to us through a centralised system.

I can tell you what every player in Australian cricket has done today. I am in Melbourne and they are all over Australia and some are in other parts of the world. If they are telling us that they are very sore today because they had a hard session yesterday, or haven't slept well, or something is hurting them, then we will speak to them and whoever their doctor or physio is at that time and adjust their plans.

The other thing that we do is screen players in all areas - physiotherapy, strength and conditioning, nutritional, a sports psychological screening. We get all that information and develop an individualised plan for each player.

SJ: What about players in lower levels, junior levels. Does information from those players also get fed into the system, or do they have to reach a certain level before they start getting reported?

AK: Yes, they have to reach a certain level. The information at the moment gets filtered down to the age of 17. We will like to take that even lower and we are working on that at the moment. The younger they become, the harder it becomes to determine who is going to make it, who is not going to make it. You don't want to spend a lot of time and energy on 14- and 15-year-olds who are never going to make it. What we do with the very young players and even players outside the elite system is try to educate the coaches and the people who interact with them. We are bringing all the Under-17 and U-19 coaches together to discuss how we are doing things at the very top level and how they can use it at the junior level.

All those T20 competitions take out months of the year, the months we use for conditioning. This is the first major break that we have had since 2007. The next such break available is in 2017

SJ: There was a lot of buzz a couple of seasons ago about injury management and the rotation policy. The pace bowlers were rested even though they were in mid-season form. What is your take on how much of that was based on inputs from you as lead physio?

AK: To be honest, nothing really has changed. It is people's perception that changes. There was no rotation policy. Rotation policy implies that you plan from the start that a player is going to play a certain game and miss the next one and play the one after. That is not what we had. When Peter Siddle ended up bowling 63 overs in a game and we had a Test match three days later, all our testing showed that he was well below where he was going into the game. We gave that information to the selectors and the coaches and they felt it was the right decision for him to not play that game.

SJ: Wasn't there an instance where Mitchell Starc was rested when he was ready to go?

AK: That is correct. Again, that is a change. He was 21 years old at that time. He had only played a handful of games for Australia and had a long injury history. He played a Test and bowled a lot of overs and we had back-to-back Tests coming up - Boxing Day Test and Sydney Test. We had a player breakdown before the game - Ben Hilfenhaus broke down and Mitchell ended up bowling 50-odd overs in that game. We told the selectors we don't think he can cope with playing both Tests back to back at his age. The selectors made the brave decision not to play him in the Boxing Day Test. That got everyone's attention. He ended up playing another 12 months. No one looks at that. If he plays that game and breaks down, we wouldn't have him for 12 months, and everyone would be saying the players aren't fit, what are you doing with them?

We took Mitchell Johnson out of the ODI series in India last year and that was a big deal for everyone. To bring him over so he can bowl in a four-day Sheffield Shield game to prepare for the first Test against England was a very brave decision by the selectors. I don't think anyone is complaining about the outcome of that. We just try to be consistent. We just manage the players. If someone bowls a lot, if someone is sore, we have the information that we think that they are going to break down, or not going to perform that well, we pass it on to the coaches and selectors and they make the decision. The player is central to that decision as well.

SJ: I want to talk a bit about the training of fast bowlers. How has it changed over the years? Wasim Akram, on this podcast, had this idea that fast bowlers need to bowl as much as they can in the nets if they want to be fit and bowl in a Test match. Colin Croft said they should run five to ten miles every day to build up strength and stamina.

AK: I have respect for anyone who has played Test cricket, particularly for someone like Wasim Akram or Glenn McGrath. The only thing I will say about that - because they were inside the tent, not inside the system, they actually don't see what the players do. One says the player should run more or bowl more. I guess they know how much today's bowlers are doing. Then it is hard to say "run more". How much have they done now? And how much more should they be doing? Unless you know what is actually being conducted, it makes it really hard to "just bowl more".

The game has changed since the 1990s. There is no time for pre-season now. All those T20 competitions take out months of the year, the months we use for conditioning. That is the biggest change. When I was with the Sri Lankans, we always had the time for conditioning blocks throughout the year with the international team. That time is not available with the Australian team now. This is the first major break that we have had since 2007. The next such break available is in 2017.

SJ: T20 and Test bowling require different types of training. Do these training programmes get in each other's way?

AK: Yes. With T20 cricket, it does not directly impact injuries. We see a few more soft-tissue injuries, like muscle strains, but there is no big impact from T20 cricket. The biggest impact that we have is that T20 tournaments are usually placed right in the middle of a season or just before a major tournament. For example, the Champions League this year is in October. The players will be exposed to four weeks' worth of four-over cricket. They are going to bowl four or five overs at training, four in the game, and then travel and bowl again the next day. What we find is that because they are only playing four-over cricket, their workloads are not high enough to step up a month or two weeks later to play Test cricket or four-day cricket, where the demands are to bowl 40 overs in five days. That is where we see the injuries. We see a spike in their workloads. I liken it to Usain Bolt going to the Olympics and running the 100m this week and next week having to run the 10k.

SJ: Do you say, "When you are done with the Champions League you have to come back to play Test matches, so you need to be upping your training levels."?

AK: Absolutely. For Test matches, players like Mitchell Johnson, who is playing in the Champions League, and who is also going to play a lot of Test matches, we have plans to maintain their workloads during the period. That won't drop to very low levels, so when they have to step up and play Test matches a week or so later, they won't struggle. As soon as there is an injury and the selectors decide they have to pick up another player, we have to make sure that the next two or three players are also ready to go.

SJ: T20 became big in 2008. Did physios in cricket around the world have to change your approach to health monitoring?

AK: Yes. It was hard to know how to adjust, because this was new. That is why we are happy in the last 12 months. We have made some changes to our planning and to our scheduling to help adjust for that. Our domestic one-day tournament used to be played at the end of the Sheffield Shield games throughout the season. Last year, we played the whole tournament in one month - October, which is the start of the season. It gave the players some consistent high-intensity bowling over a four-week period. They played two to three games a week. Then they went into Sheffield Shield cricket. What we saw was how low the injury rate was for a long time last year. We only have one year of data to support at the moment. Last year tends to support it, and we will do it this year. We will revise it a little bit and see how that works.

SJ: Based on the reports and some of the interviews during the Ashes, it was a miracle that Ryan Harris was able to pull through the Ashes and the series v South Africa. What were the things you had to do to get Rhino fit and through the series?

AK: Once again, there was team effort and central to that was Ryan Harris. He has unbelievable courage and determination. In particular, in that last Test in South Africa in Cape Town, he was struggling physically and Michael [Clarke] threw the ball to him to bowl those last couple of overs. It was a fantastic effort. That is not something I do or the doctor does. No one can instil that in someone.

SJ: How about someone like Shane Watson? He has a sculpted body achieved through many hours in the gym. But in the last few years he has been prone to injuries.

AK: Shane hasn't actually spent a lot of time at the gym. He is just fortunate that he has got the right body. He works pretty hard on his fitness. But he is a modern-day player. He plays all three forms of the game. He plays 12 months a year. We see him as injury-prone because he misses a lot of games, but he plays a lot of the games as well. He is playing throughout the year. He hasn't had a break. He had ten weeks from the time the IPL finished to the start of the Zimbabwe tour. It is the first break he has had in four to five years. He will be batting and bowling, and is pushing himself to do all things - fielding in the slips, batting in the nets, having a bowl, taking some catches. Not everyone has to do that. It is a very hard job.

SJ: A few people sent in this question: the two most exciting fast-bowling prospects to come out of Australia in the recent years are Pat Cummins and James Pattinson. What is their health status?

AK: James Pattinson is injured at the moment. His back became sore after playing in Cape Town. We have taken advantage of the long pre-season to let him recover and get him fit. We are looking to bring him back sometime in the start or middle of the Australian summer.

Pat Cummins is playing with the Australia A side against India A and South Africa A. He went to the IPL and played a couple of games. He is only 21. History tells us that with players of that age, you need to go slow. Same with Pattinson. They are very young players and you need to have patience. Mitchell Johnson was the same when he was 22-23. Everyone said he was injury-prone when he had played for only two or three years. He came through and is reaping the benefits now. That is just unfortunately the cycle of a fast bowler.

SJ: How do you see this player health management evolving in terms of preventive care?

AK: At this moment, we are looking at the most obvious things: how much they bowl, how much they run, trying to predict what is going to happen. We will have smarter systems in place going forward to help us better predict what is going to happen to the players, where we need to back off or go a little bit harder.

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